Adderall Risks: Much More Than You Wanted to Know

You mention getting prescribed in college, as a adult. How would you feel if you had been prescribed as a kid?

To me, growing up regularly taking amphetamines seems like it could twist your head pretty badly. Seems very irresponsible to be giving drugs to kids.

(I get the pressure to do it if the kid can't behave or focus and you think that's fucking up their life, but honestly, having gone through school, the fault is much more likely to lie with the school & what we expect of kids than the kids themselves...)

Vyvanse is a prodrug. That means it metabolizes into the d-enantiomer of amphetamine, whereas Adderall contains a 75-25 mixture of the d- and l-enantiomers. (Enantiomers are like left- and right-handed gloves: they have the same chemical structure, but one is the mirror image of the other. Usually two enantiomers will have similar but slightly different effects; occasionally, they can have incredibly different effects - see thalidomide for an example).

So, without further study, it's hard to know, but it's likely that Vyvanse has a similar long-term profile to Adderall, because the active ingredient (lisdexamfetamine) metabolizes into the active ingredient that makes up about 75% of Adderall.

But, it's possible that the effects described are caused by the l-enantiomer, in which case they won't apply to Vyvanse. It's also possible that lisdexamfetamine itself has its own set of effects which may either cancel out or exacerbate the effects reported by Adderall.

To give you an idea of how prodrugs can have different effects from the drug that they metabolize into: Vyvanse does have a rather nasty feedback loop for some people, because amphetamines suppress the appetite, but lisdexamfetamine is metabolized into the active ingredient using the digestive cycle[0]. For some people, this can cause a really wonky extended release cycle, where they have no appetite mid-day (due to the drug) and can't eat enough to metabolize enough dextroamphetamine to get them through the afternoon, resulting in an afternoon crash. After this wears off and they develop an appetite again (around dinnertime), they'll eat, and then the dosage that was supposed to kick in after lunch finally kicks in after dinner, causing issues sleeping.

[0] This is intentional, and it's why Vyvanse is marketed as an "abuse-resistant" alternative to Adderall, because it's theoretically harder to extract an acute dosage from it.

With insurance, my prescription is $50 / 30. I typically don't take it on weekends in order to limit tolerance, which further reduces the ongoing costs.

The adderall certainly helped me to focus, but the side effects were awful and I stopped taking it regularly. I’ve since been diagnosed with depression and started on sertraline (an SSRI), and very soon after noticed an improvement to my attention, ambition, and ability to complete tasks.

It’s not surprising, I guess, but near-constant thoughts of worthlessness/desire to die can make it quite difficult to focus on tasks and generally function.